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Therapeutics > MT 1 > Flashcards

MT 1 Flashcards

1
Q

What regulates optometry

A

The state/provincial laws

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2
Q

When was the first legal DPAs allowed for optometry

A

1971

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3
Q

When did all states of DPA

A

by end of 1980s

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4
Q

When were TPAs in all states

A

1998

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5
Q

Legend drugs

A

A drug that requires a prescription

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6
Q

DEA registration

A

When state laws support prescribing controlled substance

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7
Q

Scheduled substance

A

controlled substance. A drug that requires an authorized prescription including the practitioners DEA. the DEA schedules a drug based on risk of dependency or abuse.

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8
Q

What schedule can most optometrist prescribe

A

Schedule III. Some allow schedule II.

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9
Q

What schedule may be available over the counter if state wishes it

A

Schedule V

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10
Q

Controlled substance prescription must…

A

be written in ink, include DEA number, date, name, and address of patient, cannot be filled past 6mo of prescription, cannot be refilled more than 5 times.

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11
Q

NPI Number

A

HIPPA mandated the adoption of number. Want to improve efficiency and tracking of prescribing.

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12
Q

Informed consent age

A

15+ Exception is 16+ for first time CL fit.

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13
Q

What is informed consent

A

Tell patient about risks of the treatment

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14
Q

Informed consent legal duty

A
  1. knowing when to use aspects of doctrine 2. knowing how much info you need to divulge to patient can make informed consent
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15
Q

standard level of care

A

did the patient receive the care that an average practitioner in the area would provide?

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16
Q

Reasonable patient

A

Did the optometrist provide enough info that a reasonable pt in the same situation would make a sound judgement to proceed

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17
Q

When does the disclosure necessary increase?

A

As risk increase.

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18
Q

Topical anesthetics or eye stains

A

low risk. Minimal disclosure

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19
Q

Dilating the pupil

A

Low risk except if narrow angles or pregnant.

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20
Q

Cycloplegia

A

Low risk in most cases. minimal disclosure

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21
Q

Therapeutic agents

A

higher risks. More disclosure

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22
Q

Disclosure of anomalies

A

Best to disclose all findings to the pateint

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23
Q

Documentation

A

If it isn’t written it didn’t happen. Must document what is said to patients

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24
Q

Confidentiality training

A

Review and implement patient’s rights.

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25
Q

Keys to good TPAs

A

Be a good listener. Know you patient. Have a solid diagnosis before using any risky drugs.

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26
Q

Prescription

A

A verbal, written, or electronic order for a drug issued by a properly licensed and authorized health care practitioner.

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27
Q

OMBRA

A

Mandates that pharmacists counsel all medicaid recipients

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28
Q

Scripts

A

What prescriptions are normally written in.

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29
Q

Prescription elements

A

1 Patient’s name, age and current address (no PO boxes) 2. Date on which the prescription was written (ned for II,III, IV) 3. rx symbol 4. Medication prescribed (inscription). 4. Dispensing amount (subscription) 5. Dispensing directions (signature) 6. Patient use directions 7. Refill, special labeling, other instructions 8. Prescriber’s address, signature, phone, NPI

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30
Q

Inscription

A

Line 1. Medication prescribed. Include drug name (generic or trade), strength, formulation, no abbreviations

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31
Q

Subscription

A

Line 2. Dispensing directions. Amount pharmacist will dispense (precede by dispense). Write out amount rather than numbers

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32
Q

Signature

A

Line 3. Patient use directions. Precede by sig. Best to write out in english. Include amount of drug to take each time, when to take, route of administration, how to administer, when to stop.

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33
Q

How many drops in each 1 ml bottle

A

30 dropps

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34
Q

Auxiliary information

A

Shake well before use, for external use only, for the eye, keep refrigerated, keep out of reach of children, take with food, avoid alcohol, may cause drowsiness, take on empty stomach.

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35
Q

should you use latin on a precription

A

no felcia

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36
Q

How much [] of trade drug does generic have to have

A

95%

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37
Q

how to indicate when you want/ do not want a prescription

A

Put no substitutions or generic okay

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38
Q

are generics capitalized

A

NAH

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39
Q

Writing percent needed

A

Put 0 in front of decimal point if fractional

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40
Q

Do you use a decimal point with a trailing zero?

A

No. i.e. 500 mg not 500.00 mg

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41
Q

Generic oral drug instructions

A

Must put full active ingredient, need to include dosing

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42
Q

Do you always need % with trade names?

A

No not if only one available.

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43
Q

Trade names capitalization

A

YES

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44
Q

Ocular Surface Dryness

A

A chronic, progressive, and debilitating conditions.

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45
Q

Symptoms of ocular surface dryness

A

FB sensation, redness, burning, shining, reflex tearing, fatigue

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46
Q

How to track ocular surface dryness

A

Using questionnaire: SPEED or OSDI

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47
Q

How prevalent is evaporative dry eye?

A

80%

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48
Q

Types of EDE

A

Meiobomian gland dysfunction, exposure, poor blinking, nocturnal lagophthalmos, mechanical

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49
Q

Signs of MGD

A

Classically have thickened lid margin, telangiectasia, toothpaste expression. Not all cases have these.

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50
Q

Clinically signs with nocturnal lagothalmos

A

Ask about when eyes feel driest. Ask about sleep apnea and CPAP use. Inferior staining will be gone by PM appt

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51
Q

Korb Meibomian Gland Evaluator

A

.3lbs/square inch of consistent pressure (same as complete blink). Test 3 locations across inferior lid margin for 5 sec each. Pt needs 6/24-30 to express to be asymptomatic.

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52
Q

Lipiview II Interferometer

A

Lipid layer thickness 90 nm is good). Measures complete vs. incomplete blink. >60% indicates exposure. Blink rates are reduced with near tasks.

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53
Q

Meibography

A

Infrared photography. Duct dilation (tuning fork appearance) is the first sign of problems

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54
Q

Eyelid Transillumination

A

Screening technique instead of meiobography

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55
Q

The orb-blackie light test for lid seal

A

Hold transillumination against closed light in dark room and look for light emanating.

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56
Q

Line of Marx evaluation

A

Junction between the lid and globe, lid wiper epitheliopathy, keratinized deposit stains with vital dyes.

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57
Q

Debridement for EDE

A

Remove line of marx with gold spud following instillation of topical anesthetic.

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58
Q

MG expression (manual) for EDE

A

Removes any poor meibum and inflammatory depressed. Cold expressed at 20-30 lbs/inch. Warm (110) at 10 lbs/square inch

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59
Q

MG expression (lipiflow) for EDE

A

Single 12 min therapy results in 3x gland function improvement, 2x symptoms improves. Lasts 12 months

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60
Q

Azasite for EDE

A

azithromycin 1%. Off able use for MGD associated with blepharitis. BID x3 weeks

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61
Q

AT lipid based

A

QID. EX: systane balance, refresh. Gels and ointment for nocturnal lagothalmos

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62
Q

PF Lipid based AT

A

refresh optic advanced and retain. For pt. with sensitive or who need very frequent drops

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63
Q

Doxycycline for EDE

A

Oral. Low chronic dose from 20-100mg. Start with qd X 1 month. Action is due to anti-finalmmatory problems and not AB

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64
Q

Azithromycin for EDE

A

Better than doxy for EDE. 500 mg X 1 d, 250 mg Aq X 4d. Less expensive then doxy. SE included GI upset and effect on contraceptives. Use for 5 days

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65
Q

Omega 3 Fatty Acids for EDE

A

Fish>plant sources. Triglyceride format>ethyl ester format. ALA, EPA and DHA. EPA and DHA are precursors to anti-inflammatory lipids. Want 1,000-3,000 mg/d with at lest 600 mg of EPA/DHA per 1,000 mg. Exceeding 3,000 mg can lead to excessive bleeding.

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66
Q

How prevalent is inflammatory dry eye

A

20%

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67
Q

Cause of IDE

A

Underlying systemic disease and chronic dryness

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68
Q

SJO test for IDE

A

Blood test looking for markers associated with sjogre’s. No CLIA certification needed. 89% sensitivity and 78% specificity. Includes ANA (+78% of sjogre’s pt) plus RF.

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69
Q

RPS inflammatory test for IDE

A

Detects MMP-9 on ocular surface. Diagnosis of inflammatory dry eyes. Covered by most insurances. Requires CLIA certification.

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70
Q

Prokera Slim

A

In office tx for IDE. Amniotic membrane/biologic bandage. Promotes wound healing/healthy corneal stem cells, anti-inflammatory, anti-vascularization, anti-fibrotic, anti microbial. FDA approved alternative to bandage CL. Can be used with topical. Worn 7-10d. Covered by insurance. Gets cloudy as biologics work.

71
Q

Punctual plugs for aqueous deficit

A

Keeps tears on eyes once inflammation is under contorl

72
Q

Restatsis

A

Topical run for IDE. Cyclosporine 0.05%. 1 get in affected eye BID. CI in patient with active ocular infection. burning in 17%. Takes 3- 6 months to start working.

73
Q

Soft Steroids for IDE

A

Loteprednol, FML. QID for 1 mo, then taper to BID X 1 ml.

74
Q

Hard steroids for IDE

A

pred forte. QID 1-2 wks then taper BID X 1-2 weeks then QD X 1 wk. Some docs recommend a month of steroid use prior to starting restassis to quell inflammation. Other will use them concurrently.

75
Q

Testosterone for IDE

A

Topical cream 3% applied to upper lid QHS BID. For use in post menopausal women. Transdermal transmission. Increases lacrimal and MG function. Improves osmolarity and symptoms. Application for sjogrens patients. Off able. Need DEA.

76
Q

Who is testosterone CI in?

A

Those with breast cancer hx or prostate cancer

77
Q

Autologous Serum Eye Drops in IDE

A

Similar concept as prokera but hemopeotic stem cells instead of amniotic tissue. Made from serum of patients own blood. q4-6 hrs dosing. May be CI in pt with blood born infective disease. Expensive

78
Q

Aqueous Artificial Tears in IDE

A

QID.

79
Q

PF aqueous based artificial tears in IDE

A

QID.

80
Q

Omega 3 fatty acids and IDE

A

ALA, EPA, DHA. EPA and DHA are precursors to anti-inflammatory. lipids. Fish is better than plant. Triglyceride formula better than ethyl ester. 1,000-3,000 mg with 600mg of EPA/DHA.

81
Q

When to use what AT?

A

IDE=aqeuous based EDE=Lipid based

82
Q

Infective dry eye

A

Due to blepharitis.

83
Q

Underlying causes of infective dry eye

A

staph/strep infection. Demodex (cilia with cylindrical dandruff)

84
Q

How to find demodex

A

tug and twirl on cilia to cause mites to suface

85
Q

BlehEx

A

debridement, surgical grade PVC sponge dipped in lid scrub solution rotating at 1,000 RPM. Goal is to remove all exotoxins and scruff associated with demodex

86
Q

Tea Tree Oils Kits

A

Active ingredient is 4-terpineol. Can also use melaleuca essential oil; in office kits.

87
Q

Ivermactin

A

Broad spectrum antiparastitic for demodex infestation. 1 dose 1,000 ug/kg. Repeat after 7d.

88
Q

Best treatment for EDE

A

blinking! Every 10-15 minutes when on device. Blink sandwich. Soft, hard soft

89
Q

Modern hot compress

A

QD-BID X 20 min. Best is tranquileyes

90
Q

Eyewear

A

evaporative eyewear is aimed at keeping the individual highly functional during daily activities. Can be made with rx. EX: 7-eye

91
Q

Scleral CL

A

Reduces evaporative tears

92
Q

Lid scrubs at home

A

Aq-BID dosing. Tea tree oil derivatives. Hypochlorous acid may or may not kill demodex but can be used for maintenance after tx. (Avenova=rxn)

93
Q

Topical AB

A

Erythromycin 2% ung, bacitracin 2% ung, ivermectin (not yet FDA approved).

94
Q

Home tx for blepharitis

A

Modern hot compress/lid scrubs/omega 3/ivermectin

95
Q

Home tx for EDE

A

Modern hot compress/lid scrubs/omega 3/AB. Blink exercise/sleep shields/gel or uno PM/evaporative eyewear. Lipid based AT

96
Q

Home TX for IDE

A

Target the inflammation (topical restatisis/pulse dose steroids/autologous serum. Rheumatological meds, omega 3) Increase healthy tear volume: Aqueous based AT, sclera CL, punctual plugs.

97
Q

What causes Acute seasonal allergy conjunctivitis

A

Ragweed, pollen, grass, etc. 50% of allergic conjunctivitis are mildest

98
Q

Signs of acute seasonal allergic conjunctvitis

A

itching is a hallmark sign. papillae on lower lid. Typically bilateral, can be asymmetric.

99
Q

Acute Perennial allergic conjunctivitis cause

A

feather, dander, house dust, etc

100
Q

Acute perennial allergic conjunctivas signs

A

typically bilateral but can be asymmetric

101
Q

GPC cause

A

chronic inflammatory process vs. mechanical trauma. Caused by CL wear due to a combo of allergy to lens and deposits

102
Q

GPC signs

A

cobblestone papillae on upper lid

103
Q

Vernal keratoconjunctivitis cause

A

Chronic allergic conjunctivitis. Commonly seen in males in their teens-early 20s. Happens in warm dry climates

104
Q

Vernal keratoconjunctivitis symptoms

A

intense itching, photophobia, irritation

105
Q

Vernal keratoconjunctivitis signs

A

Palpebral VKC: non-uniform cobblestone. Limbal VKC: traktas’ or horners

106
Q

Atopic keratoconjunctivitis cause

A

Excess inflammation in the skin, lining of nose and lungs. Familial tendency. Strong association with eczema and asthma

107
Q

Atopic keratoconjunctivitis signs

A

Small/medium papillae predominantly on lower palpebral conjunctiva

108
Q

Ways to deal with allergies

A

avoid the allergen, cold compress, AT, discussion with allergist, can try to get pt to switch from oral to nasal spray to decrease effect of orals

109
Q

Mast Cell Stabilizing Antihistamines

A

PELBOPP. Immediate relief due to antihistamines. Long term relief requires compliance.

110
Q

SE of Mast cell stabilizing antihistamines

A

burning/stinging, HA, bitter or metallic taste

111
Q

Pregnancy and Mast Cell Stabilizers

A

Most are category C. Lastacraft is category B

112
Q

Patanol

A

Mast cell stabilizer antihistamine. BID. 8 hour duration

113
Q

Elestat

A

Mast cell stabilizer antihistamine. BID. Direct H1 receptor antagonist and an inhibitor of the release of histamine from cells

114
Q

Lastacraft

A

QD. Approved for 2+. H1 histamine receptor antagonist.

115
Q

Bepreve

A

BID. Approved for 2+. Highly selective H1 receptor

116
Q

Optivar

A

BID. 8-10 hours. Larger bottle-maybe cheaper. Duration of 10 hours. Reduces the influx of inflammatory cells during the early and late phase of allergy rxn. Stings!

117
Q

Pataday

A

Mast cell antihistamine stabilizer. During ion of 16 hours. AD. Relatively selective H1 antagonist and inhibitor of histamine.

118
Q

Pazeo

A

Antihistamine mast cell stabilizer. QD. As effective as lastacraft. Onset of action similar to patanol and pataday but improved symptoms at 24hrs.

119
Q

OTC antihistamine mast cell stabilizer

A

Want them with ketotifen fumarate. BID. Duration for 12 hours.

120
Q

When are topical steroid useful?

A

Severe causes of VKC, AKC, GPC, and allergic contact dermatitis.

121
Q

How do topical steroids help?

A

Decrease leukotriene and prostaglandin production, reduce capillary permeability, suppress lymphocyte circulation, inhibiting mast cell degranulation.

122
Q

How should topical steroid use be limited?

A

Only to acute suppression of symptoms because of potential SE.

123
Q

Alex (lotprednol 0.2%)

A

QID. Good for SAC. Horn’s first choice for allergic conj.

124
Q

Lotemax (lotprednol 0.5%)

A

QID. Good for GPC and prophylaxis of SAC.

125
Q

Notes about Loteprednol

A

Considered a site specific drug. Less likely to cause IOP spikes. Approved for allergic conjunctivitis. Rarely used alone.

126
Q

Topical NSAIDs

A

Specifically inhibit the enzyme cyclooxyrgenase which blocks the production of prostaglanis from arachidonic acid metabolism. Alter the patient’s sensitivity to itch. May be helpful if patient won’t take steroids.

127
Q

Acular (keterolac 0.5%)

A

Up to QID. Onset of relief within an hour. Only NSAID approved for treatment of itch. Works as an analgesic to decrease pain.

128
Q

Acular LS (Keterolac 0.4%)

A

Lower concentration so less sting

129
Q

Acular PF

A

More expensive but preservative free so less sting.

130
Q

Oral Antihistamines

A

Should be prescribed with significant nasal problems. Have drying effect on ocular surface (decrease tear production by lacrimal gland and decreased mucin production)

131
Q

Zyrtect

A

Oral Antihistamine. 5 & 10 mg tabs QD. Onset in 15-30 minutes. Available OTC but very expensive. Duration 4-24 hours.

132
Q

Allegra

A

60 mg tabs PO BID. 180 mg tabs PO QD. Available OTC.

133
Q

Clarinex

A

5 mg tab PO QD.

134
Q

Ocular Allergy Antihistamine Decongestant Combo

A

OTC. used in mild cases. Antihistamine help suppress the immunological response. Approved for 6YO. Duration of 4 hours.

135
Q

Vasocon

A

Ocular allergy antihistamine decongestant combo. QID. RXN only.

136
Q

Opcon, naphcon, visine

A

ocular allergy antihistamine decongestant combo. QID

137
Q

Vision AC

A

ocular allergy antihistamine combo. TID.

138
Q

Topical decongestants

A

OTC. Temporary relief. Used in mild cases. Not the best choice. Reduce chemises and conjunctival hyperemia. Have rebound redness.

139
Q

Topical decongestants

A

Phenylephrine, Naphalozine, Tetrahydrozaline. oxymetazoline.

140
Q

Mast cell stabilizer

A

It takes awhile for drugs to work. Can be used for months without any SE

141
Q

Alocril

A

Mast cell stabilizer. BID. Warn pt of yellow color. inhibits eosinophils, neutrophils, and macrophils

142
Q

Alamast

A

Mast cell stabilizer. BID.

143
Q

topical intranasal corticosteroids

A

Are more effective than oral antihistamines in controlling nasal blockage. Long term se can lead to elevated IOP and cataracts. Use of nasal spray + topical allergy drop more effective than nasal spray + oral antihistamine.

144
Q

cyclosporine

A

immunosuppresents. Systemic administration may be effective treatment of severe AKC.

145
Q

Similasan’s eye drop

A

homeopathic. No research showing efficacy.

146
Q

Types of human herpes viruses

A

alpha, beta, gamma

147
Q

What are all commercially available anti-vitals?

A

virustatic. Inhibit specific steps in the process of viral DNA replication in virally infected cells.

148
Q

Trifluridine

A

Generic available. 1gtt g2hrs while awake (Max 9 d) until corneal ulcers has reepitheliazed followed by 1 get q4hrs while awake for another 7d. Used to be drug of choice for HSV epithelial keratitis. Use with 6yo. Category C.

149
Q

Gancyclovir

A

topical anti-viral. 1gtt 5xd until dendritic ulcer resolves then 1gtt TID for additional 7d. 2 YO+. Drug of choice for HSV epithelial keratitis.

150
Q

What is drug of choice for HSV epithelial keratitis?

A

Gancylcovir

151
Q

Betadine solution

A

Use with EKC. 1gtt propairicane first. 4-5 get betadine.

152
Q

Acyclovir

A

Oral antiviral. 800 mg 5Xd for 7d with HZS. 400 mg 5Xd for 7d with simplex.

153
Q

Valcyclovir

A

1,000 mg 3X/d for 7d for HZV. 500 mg 3Xd for HSV. Prodrug of acyclovir.

154
Q

Famciclovir

A

Greg. category B. 500 mg 3Xd for 7d for HZV. 250 mg 3xd for 7d for HSV. Pro drug of penciclovir

155
Q

Valganiclovlir

A

Use for long term mgmt of CMV retinitis in patients with AIDS.

156
Q

Zostavax

A

Herpes zoster (shingles) vaccine. FDA approved. Used to prevent shingles in adults 60 YO.

157
Q

HSV vaccines

A

Undergoing clinical trials.

158
Q

Herpetic Eye Disease Study

A

Show that long term suppressive therapy with an oral anti viral reduced recurrence of HSV, reduced stratal recurrence by 50% among its who had the infection in the previous year.

159
Q

Treating HSV epithelial keratisis

A

Topical is sufficient

160
Q

Treat HSV storm keratisi

A

Oral

161
Q

Enothelitis

A

Topical pred

162
Q

Keratouveitis

A

topical pred

163
Q

Sodium sulfacetamide

A

don’t use. mucopurelent hampers its effectivity.

164
Q

Besivance

A

AB. Broad spectrum. TID X 7 d.

165
Q

floxacin

A

fluroquinalones.

166
Q

ciprofloxacin

A

only uno available.

167
Q

Doxycycline

A

Tetracycline. Inhibits protein synthesis. CI with pregnancy and lactation.

168
Q

Augmentin

A

Amoxicillin and clavulanic acid.

169
Q

Bacitracin

A

ung. use with blepharitis.

170
Q

Polysporin

A

bacitracin/polymyxin.

171
Q

Polytrim

A

broad spectrum. Solution only. Excellent AB for treating bacterial conj. Minimally toxic to the eye. High efficient against the most common cause of eye infection in peds

172
Q

Aminoglycosides

A

gentamicin and tobramycin.

173
Q

Tobradex

A

AB/Steroid. 1-2 get q4-6 hours

174
Q

Macrolides

A

Azasite, erythromycin, clarithromycin. ACE.

Therapeutics (1 decks)

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